T Nation

Thoughts on Estrogen and Gyno Management


#1

To understand how to truly manage this, we need to understand how estrogen is produced. Excess testosterone/androstendione is converted into estrone/estradial ( or estrogen) by the aromatase enzyme. Various sites in the body convert estrogen: the liver, adrenals, testes (in men) , ovaries (in women)and breasts (in women, and possibly gynecomastia in men). (Other factors that also increase aromatization are excess bodyfat, excess alcohol intake and opiod painkillers, among others.)

When one is on cycle, then their testicular activity is reduced significantly. I believe this is why we hear about guys bottoming out their estrogen when on cycle, even though AI's typically don't lower E that much in men. Conversely, we see men that use HCG (to keep the testes active) have more estrogen management issues. This is likely due to the estrogen conversion that they have in the testes because of their maximized testicular activity. Another factor is that androstendione is still produced, which allows for an additional conversion product to estrogen instead of simply testosterone.

In ye olde tyme days of AAS, guys typically used Proviron on cycle to control estrogen, and if necessary, Nolvadex. However, with the availability, decreased price and superior effectiveness of aromatase inhibitors, this is no longer the preferred method.

Now, you can have gyno without estrogen. Increased aromatization typically causes this to occur. However, once gyno has started, then the increased activity of the ER at breast tissue needs to be addressed. (side note: it's possible that Ostarine and other SARMs can trigger gyno, possibly by activating the ER...)


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Gyno Question
#2

Aromatase Inhibitors

These drugs prevent the aromatase activity that occurs by binding to the enzyme. Letrozole and Arimidex bind reversibly, whereas Aromasin binds irreversibly. This difference is significant, as Aromasin is less likely to cause a rebound after it is stopped, because the aromatase enzyme needs to build back up before estrogen conversion can occur. However, Letro and A-dex can become unbound, and begin conversion again.

The pharmokinetics of these differ greatly from men to women, as well. They typically reduce estrogen 35-50% in men, whereas they reduce it 75-98% in women, from a clinical perspective.

The use of an AI is clear… less estrogen means less estrogen that can bind to the ER, causing gyno.


Letrozole for Gyno Reversal without Test Cycle
#3

Selective Estrogen Receptor Modulators (SERMs)

All SERMs (Raloxifene, Nolvadex, Toremifene, Clomid) typically cause a slight increase in estrogen. However, they bind to the estrogen receptor, preventing much of the side effects. These are generally more useful in PCT than on cycle. However, Ralox and Nolva have been shown to be effective in reducing pubertal gyno, with Ralox being slightly more effective.

One might think that Nolva and Ralox are basically interchangeable for treating gyno, but I highly disagree. Nolva is significantly more effective at raising LH/testosterone than Ralox, which could lead to an increased conversion into estrogen. If we’re dealing with gyno/estrogen problems, we don’t want to add fuel to the fire. Additionally, Nolva reduces blood levels of A-dex, and possibly Letro. It?s simply better to hold off on Nolva for PCT, in my opinion.

The use of a SERM is also clear… by blocking the ER with the SERM, there is less estrogen available to cause gyno symptoms.


#4

DHT

DHT, among other things, has powerful effects on estrogen. DHT binds to the estrogen receptors, and also inhibits aromatase activity. (Andractim (DHT cream), Proviron, Masteron, Winstrol/Winny are all examples here)

An issue that some people run into in DHT heavy cycles, is where DHT is binding to progesterone receptors. An interesting effect of progesterone is an anti-inflammatory effect, specifically on joints. Hence the reason why many users find Deca (nandrolone, a progestin) to make their joints feel better on cycle. Another issue is that using any of these items in PCT will limit for HTPA recovery, as they are androgens. While DHT can help minimize estrogen issues, we can’t rely on this alone.


#5

Controlling estrogen into PCT

Some guys stop using an AI as soon as they stop using androgens, and wait a couple weeks prior to PCT (if one were using something like test enanthate or cyp.

However, plasma levels don’t immediately drop with test e/cyp. They have an approximately week long half life (4.5 days to 8 days, depending on the source). With that being said, anything above your normal level can be expected to result in an increased level of aromatization.

I typically recommend Nolva or Tore for PCT. The reason is two fold: 1. They both work at raising LH/test. And 2. They minimize side effects of high estrogen, which clomid does not do as well.

High doses of SERMS are not recommended, as a rapid rise in testosterone production can almost guarantee a rapid increase in aromatization. We want LH/testosterone levels to get back to normal in PCT, but feel free to take your time. Nolva has been shown to boost one’s test levels for 8 weeks, Tore for 12 weeks, Clomid for upwards of 6 months!

Now we can continue using an AI here but at the same time, we don’t want estrogen too low. Lower is prolly better than higher (estrogen is much more suppressive than testosterone, by the way), but it still can have some negative side effects.


#6

Below are several options for treating gyno:

Off cycle gyno reduction

Week 1-2
Aromasin-25 mg/day
Ralox-60 mg/day

Week 3-8
Ralox-60 mg/day

^some might consider this unnecessary, but if one has existing gyno, then one needs to expect it to get worse on cycle. Additionally, existing gyno might actually increase the amount of activity we have from aromatization (as the breast tissue increases this in women).


#7

On cycle

Week 1-10
Test E-500 mg
HCG-500 IU
A-dex-.25 mg EOD

Week 11
HCG-500 IU
A-dex-.25 mg EOD

Week 12
A-dex-.25 mg EOD

Week 13
A-dex-.25 mg EOD
Tore-60 mg/day

Week 14-18
Tore-60 mg/day

*have extra A-dex on hand, in case you need to increase your dose, and Ralox on hand, in case you need to manage gyno.

stopping HCG is also a viable option if you’re developing issues here. however, before one did that, i’d add in a DHT based compound first to see if that helped.


#8

For those interested in my references, i have some of them linked here in my PCT thread:


Bad Blood Results/Erection Dysfunction
#9

Great post cyco, very simple and understanding for anyone new researching this subject.


#10

[quote]BUDs wrote:
Great post cyco, very simple and understanding for anyone new researching this subject.

[/quote]

thanks!

hopefully this will help people out…

i should note, that the only clinical data i’ve seen on gyno reduction is with DHT cream, A-dex, Nolva and Ralox…


#11

Another note:

AAS users tend to dose AI’s less frequently than clinical data suggests…

with that being said, it typically takes 7 days to reach a stable blood level of A-dex and Aromasin, and 60 days with Letro ( http://clincancerres.aacrjournals.org/content/9/1/468s.full ), and that’s also with DAILY dosing (of 1 mg, 25 mg and 2.5 mg, respectively).

so what that means, is we need to begin dosing before estrogen becomes a problem (generally at the start of the cycle). Having an AI “on-hand” doesn’t help if it takes 60 days to effectively lower estrogen… it’s obviously much easier to start with a lower dose and taper it up, as needed. and, if necessary, go from EOD dosing to ED dosing…


#12

It would also appear that estrogen potentiates the exciatory hormone glutamate. I find this interesting, as several of the AI’s/SERMs are known to cause tiredness/drowsiness (Nolva, Aromasin and Femara). (And several others may cause visions issues (Clomid, Tore).)

With that being said, it appears simpler to take your AI/SERM dose in the evening. I think many people would be able to avoid some (or most) of the side effects by doing something as simple as changing their dose timing…

Personally, I get tired and a headaches from Aromasin, but if I take it at night (with supper, as food increases the absorption) I don’t notice either side effect.


#13

Great post! Thanks. This is probably the first time I’ve seen all of this info in one place.


#14

[quote]eatmorefood wrote:
Great post! Thanks. This is probably the first time I’ve seen all of this info in one place.[/quote]

Thanks!

I’m helping a friend dig up some research for a book, so i thought i’d plug this in here…


#15

Much of this I’ve read in different places. Not all. But this is a lot of info. I wanted you to know that people appreciate the effort that went into this.


#16

cyco, do you have any experience with using that cream you were talking about? I have some gyno which is basically un noticable right now but i think as i lean out it will definitely be noticable. I tried the whole letro thing but i felt like absolute shit and decided i’d rather get surgery if needed.


#17

[quote]eatliftsleep wrote:
cyco, do you have any experience with using that cream you were talking about? I have some gyno which is basically un noticable right now but i think as i lean out it will definitely be noticable. I tried the whole letro thing but i felt like absolute shit and decided i’d rather get surgery if needed. [/quote]

i have not, but it’s relatively effective, from what i’ve read:

i think if you added it in with an AI (A-dex or Aromasin) and a SERM (Ralox), then you could expect some good reduction.

EDIT: also, i think this is another case where taking the AI and SERM at night will minimize the side effects…


#18

May also be good to add to this post the importance of managing estrogen on cycle because of the unseen problems related to high estrogen.

Besides the obvious sides and the most common sides people bring up its also important to know the risks of high estrogen such as increased risk of stroke, prostate enlargement and hepatic adenoma.

I had a few links but can seem to find them, maybe I can dig them up. But it should be important to let people know about the other side effects of estrogen and why its important to run an AI and get bloodwork done around your course of ones cycle.


#19

[quote]BUDs wrote:
May also be good to add to this post the importance of managing estrogen on cycle because of the unseen problems related to high estrogen.

Besides the obvious sides and the most common sides people bring up its also important to know the risks of high estrogen such as increased risk of stroke, prostate enlargement and hepatic adenoma.

I had a few links but can seem to find them, maybe I can dig them up. But it should be important to let people know about the other side effects of estrogen and why its important to run an AI and get bloodwork done around your course of ones cycle.[/quote]

good idea!

please add the links whenever you get a chance…


#20

[quote]BUDs wrote:
May also be good to add to this post the importance of managing estrogen on cycle because of the unseen problems related to high estrogen.

Besides the obvious sides and the most common sides people bring up its also important to know the risks of high estrogen such as increased risk of stroke, prostate enlargement and hepatic adenoma.

I had a few links but can seem to find them, maybe I can dig them up. But it should be important to let people know about the other side effects of estrogen and why its important to run an AI and get bloodwork done around your course of ones cycle.[/quote]

It fucking grinds my gears the way people think that if they don’t have gyno symptoms then they’re fine. There is SO MUCH more to oestrogen management than just gyno.